If you’re over 40 and you’ve dislocated your shoulder, it probably WON’T come out again. The bigger risk is a torn rotator cuff that nobody looked for.
Somewhere between 4 and 6 in 10 people over 40 tear the cuff when they dislocate. The older you are, the more likely it is.
Many are sent home with a sling and no scan. A tear left alone can get bigger and harder to repair, so ask for an ultrasound or MRI.
The two-week test
- Two weeks after the dislocation, try to lift your arm out in front of you above shoulder height
- If you can’t, the chance of a rotator cuff tear is about 3 in 4
- Don’t wait for it to “come back on its own.” Ask for a scan and a referral to a shoulder specialist
Young shoulders come out again. Older shoulders tear the cuff on the way out.
Why it matters to catch it early
- Torn cuff muscles start to shrink and turn fatty the longer the tear is left. Scans done later tend to find bigger, less repairable tears
- Left alone, most stay painful. In one study, about 3 in 4 people with an untreated tear still had symptoms nearly three years later
- Repaired, most do well. Good or excellent results were much more common after repair than without
- Guidelines agree: people over 40 should have an ultrasound or MRI after a dislocation to check the cuff
The nerve injury that hides
- The nerve to the shoulder muscle (the axillary nerve) is often stretched when the shoulder dislocates. Older people are more at risk
- Pain masks it. Weakness gets blamed on soreness, so it’s easy to miss in the first weeks
- A numb patch on the outer upper arm can be a clue, but weakness matters more than numbness
- Most stretched nerves recover within about 12 weeks. Slower ones take six months or more
- No improvement at six weeks? Ask about a nerve conduction test
What to ask at your follow-up
- Should I have an ultrasound or MRI to check the rotator cuff?
- Is this weakness pain, a torn tendon or a nerve?
- When should I start moving the arm?
- Who do I see if I can’t lift my arm at two weeks?
What helps
- A short time in a sling for comfort, usually about a week. See how long to wear a sling
- Gentle movement early, guided by your physio, to avoid a stiff shoulder
- Progressive strengthening once a significant tear has been ruled out or treated
Go to the emergency department now if
- The shoulder is still out
- The hand is cold, pale or numb, or swelling is spreading fast
- You can’t tighten the shoulder muscle at all
Get it checked this week if
- You can’t lift your arm above shoulder height two weeks after the dislocation
- The arm feels weak even though the pain is settling
- Numbness on the outer upper arm isn’t improving
For younger people, see will a dislocated shoulder pop out again?
Over 40, the dislocation is rarely the problem. The tear it leaves behind can be.